Taiwo Arijeloye
Richmond,TX
Summary
Seasoned Medical Coding and Billing Specialist with 7+ years of experience across professional, institutional, inpatient, outpatient, and DRG auditing environments. Expert in ICD-10-CM/PCS, CPT, and HCPCS coding, MS-DRG validation, and revenue cycle management, with a proven record of maintaining 95-98% coding accuracy. Skilled in medical billing, denial management, and claims resolution, ensuring optimal reimbursement and compliance with CMS, UHDDS, HIPAA, and payer regulations. Proficient in EHR and encoder platforms including Epic, Cerner, Meditech, 3M, TruCode, and Optum. Known for analytical precision, collaborative CDI efforts, and a strong commitment to data integrity and operational efficiency in healthcare settings.
Overview
10
10
years of professional experience
1
1
Certification
Work History
ProFee Coder / (E/M) Coder, Remote
MedAr
01.2022 - Current
- Execute comprehensive coding of professional and facility encounters utilizing International Classification of Diseases, Tenth Revision, Clinical Modification, Current Procedural Terminology, and Healthcare Common Procedure Coding System for inpatient, outpatient, and Evaluation and Management services
- Lead Diagnosis-Related Group validation and documentation audits to ensure accurate reimbursement and compliance with Uniform Hospital Discharge Data Set, Centers for Medicare & Medicaid Services, and payer standards
- Partner with Clinical Documentation Improvement specialists and providers to enhance documentation clarity and boost clinical accuracy
- Evaluate and manage daily inpatient and outpatient records while maintaining a consistent coding accuracy of 95 to 98%
- Conduct regular internal coding quality audits and deliver findings to the Quality Assurance team for process improvement
- Implement medical necessity checks and National Correct Coding Initiative edits to prevent denials and enhance claim acceptance rates
- Demonstrate expertise in Epic, 3M, Optum, and TruCode encoders, updating workflows as payer rules evolve
- Partner with billing and revenue cycle teams to resolve coding discrepancies and address denials
- Engage in monthly compliance and payer policy meetings to ensure adherence to industry updates
- Boost coding throughput by 20%, decrease denials by 15%, and receive recognition for exemplary accuracy in quarterly audits
DRG Analyst / DRG Coder & Auditor, Remote
Wellstar Health Partners
01.2018 - 12.2021
- Analyzed inpatient medical records to ensure accurate assignment of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes
- Verified and recalculated Medicare Severity Diagnosis Related Groups for accurate reimbursement in accordance with payer and Centers for Medicare & Medicaid Services guidelines
- Assisted internal and external audit teams by providing detailed justifications for coding and clinical validation
- Collaborated with Clinical Documentation Improvement and case management teams to enhance provider documentation quality
- Analyzed appeals and denial letters to deliver coding-based rebuttals with supporting documentation
- Oversaw compliance metrics and conducted training sessions on coding updates and Uniform Hospital Discharge Data Set standards
- Leveraged 3M encoder and Epic to ensure documentation integrity and coding alignment
- Achieved over 95 percent accuracy and recovered more than $100,000 in denied claims through Diagnosis-Related Group reassignments
Medical Billing & Coding Specialist, Houston, TX
Memorial Hermann Health
04.2016 - 12.2017
- Oversaw the entire billing process, including claims preparation, submission, and payment posting for multi-specialty clinics
- Executed charge capture reviews, managed denials, and handled appeals to ensure accurate reimbursement
- Coded outpatient visits, surgical procedures, and diagnostic services utilizing International Classification of Diseases, Tenth Revision, Current Procedural Terminology, and Healthcare Common Procedure Coding System standards
- Conducted verification of insurance eligibility, processed prior authorizations, and assisted patients with billing inquiries
- Compiled regular revenue reports for management and finance teams
- Increased claim acceptance rates to 98%; decreased accounts receivable aging by 15 days; optimized patient billing workflows
Education
MBA - Information Technology Management
Western Governor University
UTBSc - Criminal Justice
John Jay College of Criminal Justice
NYSkills
- Medical Coding Expertise
- ICD-10-CM / ICD-10-PCS / CPT / HCPCS Coding Evaluation & Management (E/M) Leveling ProFee and Facility Coding DRG and APR-DRG Validation Inpatient, Outpatient, and Ambulatory Coding Charge Capture Review Modifiers & NCCI Edits
- Encounter Data Review Denial Analysis & Rework Query Development Clinical Documentation Improvement (CDI) Revenue Integrity Audits Hierarchical Condition Categories (HCC) Coding Risk Adjustment & Quality Reporting Auditing (Internal & External) Coding Compliance Review
- Medical Billing & Revenue Cycle Management
- Charge Entry Insurance Verification & Eligibility Claims Submission (UB-04, CMS-1500) Electronic Remittance Advice (ERA) Review Denials & Appeals Resolution Claim Status & Resubmission Coordination of Benefits (COB) Payment Posting & Adjustments Explanation of Benefits (EOB) Reconciliation Accounts Receivable Follow-Up Refunds & Credit Balances
- Patient Billing & Collections Financial Counseling Payer Policy Interpretation Managed Care & Medicare/Medicaid Processes Revenue Optimization Strategies
- Compliance & Regulatory Standards
- CMS & OIG Guidelines HIPAA / HITECH Compliance UHDDS Standards Coding Ethics & Auditing Standards (AAPC, AHIMA) NCAC & LCD/NCD CDI Policy Application Medical Necessity Review Paper-Specific Compliance Documentation Integrity Audit Response & Corrective Action Plans Quality Assurance & Risk Mitigation
- Medical Office Administration
- Patient Registration & Scheduling Health Information Management (HIM) Medical Record Review Interdepartmental Coordination (Coding, Billing, CDI, Finance) Provider Education & Query Resolution Credentialing Support Claims Tracking Systems Data Entry Accuracy Workflow Optimization Time & Task Management Communication & Customer Service
- Technical Proficiency
- EHR Systems: Epic, Cerner, Meditech, Kareo, eClinicalWorks, NextGen Encoder Software: 3M, TruCode, Optum Billing Systems: Medpoint, Navinet, Availity, Waystar Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) Jira, Zendesk, VPNs, and Remote Coding Platforms Data Validation & Reporting Tools
Certification
- Certified Professional Coder (CPC), AAPC
- Certified Coding Specialist (CCS)
Timeline
ProFee Coder / (E/M) Coder, Remote
MedAr
01.2022 - Current
DRG Analyst / DRG Coder & Auditor, Remote
Wellstar Health Partners
01.2018 - 12.2021
Medical Billing & Coding Specialist, Houston, TX
Memorial Hermann Health
04.2016 - 12.2017
BSc - Criminal Justice
John Jay College of Criminal Justice
MBA - Information Technology Management
Western Governor University